TOBACCO SMOKING INCREASES THE RISK OF DEATH FROM PNEUMOCOCCAL PNEUMONIA.

Chest

PubMedID: 24811098

Bello S, Menendez R, Torres A, Reyes S, Zalacain R, Capelastegui A, Aspa J, Borderias L, Martin-Villasclaras JJ, Alfageme I, Rodríguez de Castro F, Rello J, Molinos L, Ruiz-Manzano J. TOBACCO SMOKING INCREASES THE RISK OF DEATH FROM PNEUMOCOCCAL PNEUMONIA. Chest. 2014;146(4):1029-37.
ABSTRACT BACKGROUND
Active smoking increases the risk of developing community-acquired pneumonia (CAP) and invasive pneumococcal disease (IPD), although its impact on mortality in pneumococcal CAP outcomes remains unclear. The aim of the study was to investigate the influence of current smoking status in pneumococcal CAP mortality.

METHODS
We performed a multicentre, prospective observational cohort study in 4288 hospitalized CAP cases. The study group consisted of 892 patients with pneumococcal CAP: 204 (22.8%) current smokers, 387 (43.4%) non-smokers and 301 (33.7%) ex-smokers.

RESULTS
Mortality at 30 days was 3.9%; 4.9% in current smokers vs. 4.3% in nonsmokers and 2.6% in ex-smokers. Currently smoking CAP patients were younger (51 vs 74 years), with more alcohol abuse and fewer cardiac, renal and asthma diseases. Current smokers showed lower CURB65 although 40% of them had severe sepsis at diagnosis. Current smoking was an independent risk factor (OR, 5.0; 95% CI, 1.8-13.5; p=0.001) for 30-day mortality of pneumococcal CAP, after adjusting for age (OR, 1.06; p=0.001), liver disease (OR, 4.5), sepsis (OR, 2.3), antibiotic adherence to guidelines and first dose <6 hours. The independent risk effect of current smokers remained when compared only to non-smokers (OR, 4.0; 95% CI, 1.3-12.6; p=0.015) or to ex-smokers (OR, 3.9; 95% CI, 1.09-4.95; p=0.02).

CONCLUSIONS
Current smokers with pneumococcal CAP often develop severe sepsis and requires hospitalization at a younger age despite fewer comorbid conditions. Smoking increases the risk of 30-day mortality independently of tobacco-related co-morbidity, age and comorbid conditions. Current smokers should be actively targeted for preventive strategies.